James R. Mirick sets the record straight on things he cares about

Health and Health Care Fallacies

For the last month or so I have been dealing with my Father’s final illness and ultimate passing away. At 91, he broke his hip, had it fixed, but ultimately succumbed to the aftereffects of the operation. We will miss him, but his body was very run-down and it was just his time. OK now, during this time he was in the ER twice, on a floor for a week while they adjusted his blood chemistry, had the hip replacement operation, back on the floor for a week of recovery, and 3 days in what was hoped to be a rehab situation, before he died. As is the case with our current health-care cost allocation approach, for him this was covered mainly by Medicare. It was excellent, high-tech care proving we really know how to take care of the acutely ill, especially the elderly. So far, so good.

The next situation is a little different. My daughter Sarah graduates from college in May, and with her graduation she is dropped from our health insurance, which comes through my wife’s work. We can continue to cover her through that policy, but at a relatively large cost, and that cost is large enough that it can only be seen as a considered disincentive to continue it. We can of course get other coverage, and at a considerably lower cost, but also with lower benefits.

But it brings right up to your own doorstep the issue of how your own kids can drop right out of the safety net with no problem. Why should her ability to be able to afford regular health care be dependent on where somebody works? When she graduates from college, is she no longer worth coverage? Why, for that matter, should her health care be dependent on what some company is willing to provide for? I mean, what if she has such high deductibles that a significant accident or illness would bankrupt her, but that’s all she could afford on her earnings? It’s not like she would be too stupid to bother with health insurance. Is this some kind of perverse incentive to force her to get a better job?

Then, in a recent article in Slate, there’s a very good discussion of our distorted focus on certain very low-probability causes of cancers to the exclusion of a focus on common, low-tech ways to dramatically reduce cancers in the public at large. For example, we obsess about asbestos, DES, and cell phones as cancer-o-gens, but ignore human papilloma virus immunization, aflatoxin exposure, or exposure to UV-A which are all vastly worse. Worse, we have had public fights where religious zealots demand that the government NOT immunize their children against HPV, apparently on the theory that to protect them from cervical cancer is to thwart the Will of the Lord God Almighty if they should misbehave and thereby pick up HPV.

Finally, in a complete abrogation of the concept of shared risk insurance, some especially greedy health insurance providers have set up a scheme to remove people who have MS, cancer, or some other diseases that have very expensive medicines from the pool of prescription coverage and charge them ruinous rates for their drugs, many of which literally keep them alive. I on the other hand, get my blood-pressure medicine for nothing — that is, zero — through my wife’s plan. Isn’t this what insurance is supposed to do, spread the risk to everyone? Couldn’t I pay $5 more for mine, so these people wouldn’t have to pay $3,500 per month just to live? Why don’t the insurance companies adjust their rates and just get down to covering people for whatever goes wrong with them?

And the penalties for a mistake are horrendous — miss a day of coverage (after graduation, say) fall down and rupture your spleen, and instant financial ruin. And the benefit of this coverage gap being allowed to happen is . . . what? Who benefits but the insurance companies?

So, seems like kind of a dislocated system. Some people are lucky to have great coverage, some have trouble getting any, there can be inadvertent gaps, and the net-net cost can range from near-zero to bankruptcy, and the difference is almost random — who you work for, whether their carrier has a good plan (and whether the employer chose to offer it), and whether you guessed right and chose the right level of coverage for whatever ultimately befell you. Ditto for this business of “health savings accounts” which assume that you as an individual can somehow predict your medical costs for the year. If skilled professionals at the insurance companies can’t do this successfully for large pools of people, how am I supposed to do so for my own family? What secret skill would save me when I do this? Me, or some delivery-truck driver, or anybody?